DuncanBaily, Foundation Year 2 Doctor, North West Thames Foundation School

I am grateful for Dr Vris-Uss’ reply, and acknowledge her point that the MHRA has advised patients at risk of anaphylaxis should carry two adrenaline auto-injectors (AAIs), though no comment on dose is made in that advice.1

I agree that the Resuscitation Council’s guidance is intended for healthcare professionals treating anaphylaxis.2 The guidance from the British Society for Allergy and Clinical Immunology (BSACI) that applies specifically to AAIs for self-administration does not provide advice on the dose.3

In the absence of specific guidance on the dosing of AAIs intended for self-administration, the dose advised for administration by the same route by healthcare professionals offers a sensible starting point. The purpose of AAIs is to allow patients to give immediately the treatment for anaphylaxis that a healthcare professional would if they were present. It should be noted that repeat doses of adrenaline are often necessary and not considered unsafe and that two AAIs are often provided to patients. 500µg AAIs may not be appropriate for some adult patients (for example those weighing less than 50kg.) However the finding that of those patients who would likely receive a 500µg dose of adrenaline from a healthcare professional, 97% had been prescribed a significantly smaller dose to administer to themselves in the event of anaphylaxis was felt to pose...

I am grateful for Dr Vris-Uss’ reply, and acknowledge her point that the MHRA has advised patients at risk of anaphylaxis should carry two adrenaline auto-injectors (AAIs), though no comment on dose is made in that advice.1

I agree that the Resuscitation Council’s guidance is intended for healthcare professionals treating anaphylaxis.2 The guidance from the British Society for Allergy and Clinical Immunology (BSACI) that applies specifically to AAIs for self-administration does not provide advice on the dose.3

In the absence of specific guidance on the dosing of AAIs intended for self-administration, the dose advised for administration by the same route by healthcare professionals offers a sensible starting point. The purpose of AAIs is to allow patients to give immediately the treatment for anaphylaxis that a healthcare professional would if they were present. It should be noted that repeat doses of adrenaline are often necessary and not considered unsafe and that two AAIs are often provided to patients. 500µg AAIs may not be appropriate for some adult patients (for example those weighing less than 50kg.) However the finding that of those patients who would likely receive a 500µg dose of adrenaline from a healthcare professional, 97% had been prescribed a significantly smaller dose to administer to themselves in the event of anaphylaxis was felt to pose a potential risk.4

In your October edition, Dr Duncan Baily makes reference to the under prescribing of a 500µg dose strength of adrenaline auto-injectors for patients at risk of anaphylaxis. Further, he comments on the lack of availability of such a dose for the most commonly prescribed auto-injectors.

I fear Dr Baily has misinterpreted the guidelines and, as such, has drawn the wrong conclusions following his audit. The recommendation for use of a 500µg dose of intramuscular adrenaline, for the acute treatment of anaphylaxis, is intended for administration by healthcare professionals only.1

There is no such dose recommendation for patients who require adrenaline for self-administration. Recent MHRA guidance is that patients should be prescribed two adrenaline auto-injectors, which patients should carry with them at all times.2

As stated by Dr Baily, prescribing the wrong dose of adrenalinen may put patient safety at risk. I would be most grateful if you could please clarify the correct MHRA guidance for your readers.

References

1. Working Group of the Resuscitation Council (UK). Emergency treatment of anaphylactic reactions, Guidelines for healthcare providers, January 2008, Review 2016.

In your October edition, Dr Duncan Baily makes reference to the under prescribing of a 500µg dose strength of adrenaline auto-injectors for patients at risk of anaphylaxis. Further, he comments on the lack of availability of such a dose for the most commonly prescribed auto-injectors.

I fear Dr Baily has misinterpreted the guidelines and, as such, has drawn the wrong conclusions following his audit. The recommendation for use of a 500µg dose of intramuscular adrenaline, for the acute treatment of anaphylaxis, is intended for administration by healthcare professionals only.1

There is no such dose recommendation for patients who require adrenaline for self-administration. Recent MHRA guidance is that patients should be prescribed two adrenaline auto-injectors, which patients should carry with them at all times.2

As stated by Dr Baily, prescribing the wrong dose of adrenalinen may put patient safety at risk. I would be most grateful if you could please clarify the correct MHRA guidance for your readers.

References

1. Working Group of the Resuscitation Council (UK). Emergency treatment of anaphylactic reactions, Guidelines for healthcare providers, January 2008, Review 2016.

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